According to the data from National Bureau of Statistics of China, the elderly over 60 accounted for 16.7 percent of the 1.38 billion Chinese population in 2016, of which those over 65 accounted for 10.8 percent.
Based on data from the United Nations, these two percentages are both 1.5 times the standard throughout the world, which means that China has entered rapidly into an aging society.

The sharp growth of people over 65 means that families and the government will face a huge burden of pensions and healthcare in the future.

In Guangzhou, which has more than 13 million people, there are three categories of nursing rooms for the elderly: publicly owned, non-profit privately owned, and commercial privately owned. Public pension institutions, non-profit private pension institutions, and rural nursing homes charge based on a government system. For-profit private pension service fees are based on the market.

The residents at Haochen Nursing Home eat dinner.

The government of Guangzhou supports non-profit private nursing homes with ¥100 to ¥200 per patient a month, and ¥150 to ¥300 per patient in commercial ones. For public facilities, the government promises priority for three kinds of people: the elderly with no income, no productive capacity, and no dependency; low-income elderly; and the elderly who have specific health problems.

Because there’s no social insurance specifically for nursing homes, people have to pay with their pensions. The average corporate pension in Guangzhou was ¥3,316 per month in 2015.

Located in Haizhu Square, the Cixin Nursing Home is a non-profit, privately owned institution. Zhang chose it because of its convenient location and the relatively appropriate price.

“We’ve seen many nursing rooms. Public ones are not possible to get in, and private ones are always available, but all with many kinds of additional costs.” Cixin charges Zhang’s mother about ¥3,000 per month. Besides that, one-time “sponsor fee” of ¥20,000 to ¥40,000 is also required.

“How much money it exactly requires depends on the condition of the room, but the fee is used for nothing but sponsorship.”

In Guangzhou, the monthly charges of private nursing homes are from about ¥3,000 to ¥10,000 per month. And the sponsor fee is an extra requirement. It is like an entrance fee but is called a “sponsor fee” to avoid government regulations.

For example, to get a room in Yi Fuju, generally considered the best local nursing home, for 20 years, costs ¥300,000 excluding food and nursing fees, according to Liu Yanjiao, the marketing customer service staff.

On the official website of the Department of Civil Affairs, there are 128 registered pension institutions in Guangzhou, containing 41,336 beds. In 2015, there were 1.47 million people over 60 years old in Guangzhou.

That means there are about 28 beds for every 1,000 elderly people. Based on the Circular of the General Office of the State Council on Printing and Distributing the Construction Plan of Social Pension Service (2011-2015), the government’s goal was to guarantee 30 beds for every 1,000 elderly people. The results show that even Guangzhou, one of the most developed cities in China, hasn’t achieved the government’s plan.

Most of the elderly in China don’t want to spend their lives in a nursing home. And what’s more, the relatively high and hidden costs deter many families from using such nursing institutions.

Haochen Nursing Home is a government-supported private institute. Located on a narrow road, it has only 180 beds that each cost about ¥4,000 to ¥6,000 per month.

A nursing home care worker, Huang Guanqing, said he feels the burden of the increasing number of elderly people.

“I’ve been working here since 2009. I only had to take care of three to five people simultaneously then, but now my job is nine,” said Huang.

By state regulation, the equipment ratio of care workers in nursing homes should be one worker for every three to five patients. Most of the institutions can’t meet the standard. And with the intensive work, low wages, and little social respect, fewer people have the desire to work in this field.

Nevertheless, Guangzhou is making progress on this issue. In late 2016, the Guangzhou government published regulations that provide the direction for strengthening the services for the elderly, such as the minimum standard of care workers and the allocation of bonuses for those who have been working as care workers for over five to 10 years. This regulation provides clear instructions for increasing treatment to make up for the elderly caregiver gap and the shortage of workers.

Moreover, an online registration system has been created for people who want to be in a public nursing home in Guangzhou. Once an individual registers, an assessment begins that analyzes the patient’s physical and financial condition. Unfortunately, this process takes time, so patients qualify slowly. Thousands of people are waiting, but less than three percent of them have begun the assessment process.

Another change in the system is a new policy called long-term care insurance through which people can get 70 percent of their nursing fees reimbursed. But it can be costly.

Zhang, the 71-year-old man, is facing his own pension problem in the near future.

“I hope that one day the charges can be reasonable so that I can afford the costs with my own pension, which is about ¥4,000 per month,” said Zhang, “The only reason that I will choose nursing homes is not to bother my children.”